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False Positive stress test
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False Positive stress test

I have had no chest pains and have felt fine.  My GP ordered EKG because I am over 40, that was abnormal, I then had stress test which showed blockage.  On Tuesday I underwent heart catherization and was found to be a false positive.  I don't know what to do now.  Again I feel fine but I am now very sceptical of any test results.  I have diabetes and my father died from a massive heart attack at the age of 54 so I don't want to dismiss test results but am not sure of my next course of action.  Is there a test that is more reliable?


This discussion is related to A false Positive result.
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159619_tn?1318997813
Nothing is more accurate than a cath, if it was clear you're in good shape as it is 100% accurate.

Congrats!

Jon
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976897_tn?1379171202
I am concerned that the EKG was abnormal. In what way was it abnormal?
An EKG basically measures the electrical impulses across the chambers of the heart and a lot can be discovered from this, but not everything.
A Cath is only good for seeing inside the Coronary Arteries, it does not show the condition of valves and chambers. To be absolutely sure, I think you should have an echocardiogram. This will see the heart functioning and how each chamber is behaving and how each of the four valves are performing. There are 3D echo machines in many hospitals now and the images are amazing. It will also allow the operator to measure the wall thicknesses and the chamber sizes as well as the efficiency of the heart.
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159619_tn?1318997813
An echo would be nice, but keep in mind that an abnormal EKG is very often the result of an incorrect placement of a lead. That happened to me on my last EKG as well, leads were replaced and everything was fine. One thing to remember is that the echo will be looking at your heart structure. If you were sent for something as drastic as a cath it would have been because your doctor suspected something on the EKG  represented the possibility of some coronary artery disease or a previous MI with muscle damage, both of which would have shown up on a cath. I find it difficult to believe that your doctor would have gone directly to a cath if he saw something on an EKG that may have been related to the electrical pathways or structure of your heart, especially if you are feeling fine as you say.

You should have him clarify what the abnormality was. You can then make an educated decision. If it were me and I was feeling good and had a clear cath, I would be very happy!

Good luck!

Jon

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367994_tn?1304957193
I agree with Jon the selectivity and sensitivy is not very good for much other than electrical (rhythm) disorders.  Big jump from EKG to a cath...there almost has to be some evidence or believe for ischemia (pathologically decrease in blood/oxygen flow).
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976897_tn?1379171202
"possibility of some coronary artery disease or a previous MI with muscle damage, both of which would have shown up on a cath"

I was totally unaware of that. I had a Cath and then had to have an echo followed by a nuclear scan to be sure if there was any tissue damage. When I've looked at the monitor during my 5 caths I've never seen anything resembling what could be tissue damage, just Coronary Arteries. What does it look like on the monitor?
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976897_tn?1379171202
I would also like to just clarify that the GP took an EKG which was abnormal. He then had a stress test which involves being wired up (12 wires) to an EKG machine which also
showed abnormality making them believe there was a blockage. During a Cath you are
also wired up to EKG monitoring so I'm sure a lead defect would have been noticed out of the three occassions.
In the UK you are given a pre assessment before the cath, usually a few days before and this includes an EKG. On the day of the procedure, as soon as you arrive you have another EKG followed by a chest X-ray. What is the normal protocol in your Country for such procedures?
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159619_tn?1318997813
ed,

My understanding (having never had a cath) is that they can see the termination of blood flow to a given area of the heart. No blood flow equals blocked artery and muscle damage. If they did not see any blockage there would not be any muscle damage by exclusion.

As far as protocol goes here, it is VERY uncommon for someone to have a cath based on the findings of an EKG. That's why I have to think that the doctor reading the EKG was concerned about the nature of the abnormality and thought it severe enough for a cath, very unusual. The next step is typically a nuclear stress test.

Jon
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976897_tn?1379171202
well no an angiogram cannot determine damaged tissue which was proved in my case where the LAD was so severely blocked. The Cardiologist and his colleagues stented my circumflex but left the LAD at the time because they felt there would be tissue damage. This was the general consensus. An echocardiogram was performed which could find no tissue damage and the Cardiologists refused to believe the results stating "An echo doesn't always give accurate enough readings". I was then sent to have a nuclear scan which concured with the echo and shocked the cardiologists. You cannot 'see' tissue damage during an angiogram, all you can do is 'assume/guess'.
On arrival at hospital during MI, an ECG was the first test taken and this somehow told a Cardiologist I needed emergency stenting which was a very accurate diagnosis. Later as I was being transferred to another hospital by ambulance, the blood test results showed my troponin level agreed with the ECG.
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159619_tn?1318997813
ed,

Your case certainly sounds like the proverbial exception to the rule. When looking at these posts I always look at the norms, what is usually done, protocols followed in the normal course of events with predicted outcomes. If you read the OP, she is having no symptoms, just an abnormal EKG so I don't know that I would make the assumption that your situation is comparable to the OP. Posting experiences like this can lead to unnecessary anxiety.

What I find interesting about this post is that she went directly to a cath from an EKG. It was either a very savvy doctor that read something indicating ischemia or a doctor that was not very savvy in reading an EKG. In any case, no symptoms and a clear cath normally rules out coronary disease, I don't think a worst case scenario should be applied, this is a pretty simple case of an incorrectly read EKG, in my opinion. I'm no doctor but I don't think I would be chasing additional tests and risking further false positive results which could lead to more invasive and expensive procedures not to mention the anxiety. If she was experiencing symptoms I would think otherwise.

Jon
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Avatar_n_tn
Hi all,

I appreciate all of the thoughtful advice and discussion.  To clarify, I did undergo a nuclear stress test prior to my heart cath.  The stress test indicated there was blockage in one of the arteries.  So I was stunned when I was told that I was a false positive and there was no blockage!  I thought that a stress test was more reliable!  I think my physician was being extra cautious because I have diabetes and because my father died of a massive heart attack at the age of 54.  

I guess I am now trying to figure out what do I do now?  How can I take these tests seriously when they can be so wrong?  My sister said to me that your heart may be fine but they've messed with your head.  I totally agree.

missyblue 260
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159619_tn?1318997813
The most important test was the cath and it was normal, showing no blockages. A cath is the gold standard in testing and is 100% accurate. I think that given you have no symptoms and you had a clean cath, you're heart is in great shape. Personally, I would be thrilled!

Also, glad to hear they did a nuclear stress test, that makes more sense. To put it in perspective, nuclear stress tests are about 85% accurate and do result in false positives more often than false negatives. Parts of the heart can be difficult to see due to soft tissue attenuation, it's very common. These areas will show as parts of the heart not getting enough blood which causes a false positive.

I would go forward without worry but given your risk factors, make sure you eat right, get some daily exercise and get checked out every few years, sooner if you develop symptoms. You have a great starting point.

Good luck!

Jon
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976897_tn?1379171202
ah, now it makes perfect sense. However I am surprised that the wrong diagnosis was given from the nuclear scan. The scans are interpreted by specialists and the results are then sent to the cardiologist. Maybe the wrong results were sent for the wrong patient? which sounds more likely than them being misinterpreted because ischaemia is not hard to spot. Wrong papers in the wrong records is not unknown, unfortunately.
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976897_tn?1379171202
"Your case certainly sounds like the proverbial exception to the rule"

In what specific way? I think my case is perfectly to the norm.
1.  MI Episodes
2.  Sent for emergency Angio due to results of ECG/Troponin levels
3.  Stent inserted into Circumflex, LAD noted to be occluded.

There is no point in stenting/bypassing a vessel if the tisue is dead, it will be a waste of time.

4.  Echocardiogram
5.  Stress test
6.  Nuclear perfusion scan
7.  Triple bypass (failed)
8.  Stents to LAD

Which particular event did my cardiologist make an error on which is not to normal protocol?
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976897_tn?1379171202
I'm not sure who made you a moderator of this forum but you can't post comments about me on this thread and not expect me to respond. I did get your message and Im
currently deciding on what to do with it. Maybe I should post it into a new thread and let people make up their own minds what they want from this forum. I've only had complaints from you, nobody else. I've had lots of messages thanking me though.
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159619_tn?1318997813
Let me explain, you wrote in your post;

" An echocardiogram was performed which could find no tissue damage and the Cardiologists refused to believe the results stating "An echo doesn't always give accurate enough readings". I was then sent to have a nuclear scan which concured with the echo and shocked the cardiologists"

I was only pointing out that a nuclear stress test has an overall accuracy rate of 85% and a specificity of 93% meaning that 7% of normal results will be a false negative. Since you fell into the 7% group I mentioned you were the exception to the rule. I did not mean to imply your doctor missed anything.
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Avatar_n_tn
Thanks for all the advice.  This whole episode has really freaked me out.  I have always tried to take care of myself but there is always room for improvement so I am trying to see this as a wakeup call to do better, exercise more, eat right, yada yada.  I guess what I am feeling is disillusionment, I thought these tests were more reliable.  I believed from the beginning that my doctors were being extra cautiuos because of my medical history and I appreciate that I just don't want this episode to make me suspicious of test results because next time there really could be something wrong!
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328381_tn?1269367702
i would have to agree with ed34 ive had 6 caths and lots of extensive tests we base our opinion on actual experiences not from reading tons of blogs
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976897_tn?1379171202
Hi Max,
            In retrospect you are half right really. I've asked certain questions to the 9 cardiologists that I have seen over the last two years and not one of them have ever had any kind of heart procedures. Now, ask a surgeon how you will feel after a bypass and in reality they don't have a clue. I was told I would feel a very small amount of discomfort which was total bull****. When I woke up, I couldn't believe the pain, even with medication. Every breath was like being punched in the chest very hard. There are obviously many things in life that you have to experience to gain the knowledge to discuss them. Imagine you have never experienced a fast car ride over a hill and someone asks you what it feels like. You explain how your stomach goes funny, but do you think they really have a clue what you are saying. With technical issues, patients do learn very quickly about their conditions because human nature leans them towards asking their consultants lots of questions.
What has surprised me most of all having been through so many cardiologists, is that they all have different opinions. No two had the same conclusion with my case. One said I would have to have a transplant, another a redo bypass, another an open end type arterectomy, another rotablation, another said nothing should be done. The list went on and in the end who had to decipher the decisions and make the right choice. Not the experts, but me. At the end of the day the experts are suppose to analyse your problem and 'recommend' at least one solution. They should not make that choice the definitive one because other options are usually available. My head was a mess trying to handle all the contradicting advice. If the experts had the same training and give the best advice, then things would be easier. If I had listened to the first option, I would be very sick by now and probably still on a transplant list and how long would another heart have lasted me. Nothing is straight forward my friend and that's why people are coming to forums like this one, to try and make sense of it all. It also helps people to see different perspectives.
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976897_tn?1379171202
On a final note really, Doctors do a very good job and yet they are human just like us and are prone to error. Millions of misdiagnosis are made each year and I believe when we have a problem it is up to us to try and make sense of the situation. If you had a pain in your hand and a Doctor said you need to have a foot amputated, you would seek a second opinion. If you are then told you have to have your leg off, you would seek a third opinion. I know they are exaggerations but it's just as example. Millions of people are given angiograms only to find there is no blockage.
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Avatar_m_tn
QUOTE:"i would have to agree with ed34 ive had 6 caths and lots of extensive tests we base our opinion on actual experiences not from reading tons of blogs."


Blogs are reading material and your above comment is stupid with a foolish attempt to explain on you recent post.  Regardess It seems you are against those that have knowledge of a subject that you refer to as "blogs" and have disdain for those individuals that have more knowldge on a subject than you...so you use a medical procedure you have had in a stupid attempt to give you credibility and special knowledge of the subject.

I have absolutely no respect for you!.  Your actions are those of slobberiing, sniffling, sycophant and that is clearly demonstrated by your incoherent utterances.  GET OUT OF THIS ARENA,  you are in over-your-head and the moronic quote indicates you have very poor judgement and a complete failure to think logically!  

I regret getting down to your level to make a point
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328381_tn?1269367702
these forums are for the poster not for you to keep writing on someones thread to put peopledown does it make you feel better you must have little man complex and i know i may not know everything like you do but i am learning from my cardioligst and heart surgeon all the time about my heart.
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Avatar_m_tn
QUOTE:"i would have to agree with ed34 ive had 6 caths and lots of extensive tests we base our opinion on actual experiences not from reading tons of blogs." by cblmn!!

You can't put lipstick on a pig, it is still a pig!. You should apologize to whomever you are referring to in that message. You are trying to put down someone on this thread that has/had an interest in making a worthy contribution and helping the original poster and other posters.  And you attack the unnamed individual by implying reading "blogs" not qualify (how could you possibly know what a person reads?) reading tons of "blogs" (you implied a reading background does not equate to the experience you and the other poster had so take the backseat to us!), and your cravenness is also distinquished by including another person who spins message and does not defend the stupid statement! "   You should apologize!  It is your behavior and stupid comments that is the issue.  

QUOTE: "i am learning from my cardioligst and heart surgeon all the time about my heart".  

>>>Now, you have made an inconsistant utterance. So one's learning qualifies when it comes from a doctor, but having relevant information read and communication with individuals with CAD doesn't qualify unless you have had CAD and stents and answers from your doctors,  Utterly rediculous!

You are the one who puts people down.  Apologize or make a retraction of your utterances.  Don't try and weasle out.  Be a man or lady, whatever, that would be nice of you.
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328381_tn?1269367702
I didnt put anyone down i just made a statement and as for taking a drs opinion over someone who reads forums you bet i would, they have the knowledge. people come here for questions to ask a dr or maybe what direction to go but to take someones advice on a forum over a dr is just stupid. you can hire a plumber that read how to fix a car  to work on your car instead of a auto mechanic not me
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Avatar_m_tn
You wrote and I quote; QUOTE:"i would have to agree with ed34 ive had 6 caths and lots of extensive tests we base our opinion on actual experiences not from reading tons of blogs." by cblmn!!
AND NOW
" didnt put anyone down i just made a statement and as for taking a drs opinion over someone who reads forums you bet i would, they have the knowledge. people come here for questions to ask a dr or maybe what direction to go but to take someones advice on a forum over a dr is just stupid. you can hire a plumber that read how to fix a car  to work on your car instead of a auto mechanic not me"
_____________________________________________________
Thanks for getting to the point of your prior comments.  You should know that I have been a long time reader of this board, and I know the culture and many contributers that have donated their time to help people understand their problem. My observation is you do not make any contribution by any of your comments that I have ever read!

You and ed are relatively new to the heart disease forum, but you guys (gal?) should know that the Board/forums have a disclaimer and stating all responses from members should NOT be considered advise. Have the read the disclaimer? Also, this forum provides links to discussions on what they believe is relevant information..  Do you reject links as part of the forum's culture to encourage discussions, and do you consider that  giving medical advise?  If so, please explain the difference between that and answering posts by members of the forum on the subject of current concern?  This thread brings out your stated bias against members discussing a subject that has nothing to do with giving medical advise, so how do you reconcile anything said on this thread to be giving medical advise?...it relates to a procedure that any nurse, technician, or readers of past posts would know....doesn't require a doctor.  Relying on doctor's advise is only as good as asking the correct question,having enough knowledge to know the correct question and understanding the answers...requires knowledge gained by self eduction such as  reading and asking questions of a medical forum.  Admit it, you are confused and make things up as you go along attempting to jusify the original stupid comment.  Get with the program.

Because you brought Ed (a member) into your biased comment, I will comment: Ed often gives medical advise.  One comes to mind is a statement regarding free radicals in the blood, and he gave medical advise to follow a certain procedure and he continues "don't eat one day out of the week!".  Another time when he was challenged on his post, he stated: ..."am I suppose to ignore everything I have read?"etc. etc. It is possible some people may be harmed from his unbridled comments, Do you agree or disagree?   Maybe you would be harmed, but I wouldn't!  But to be harmed is possible as it may apply to you and similar thinking individuals, and should be a consideration.  That is the purpose of the disclaimer, and now you know about the disclaimer.
  
To belittle someone's years of discussion and possibly some research on the subject, discussed, should not be dismissed as knowing less than someone who has had 7 stents implanted is ridiculous.  Stop wearing your 7 stents on your sleeve, apply yourself to self-education by research, reading relevant links provided by the forum, keep an open mind, be involved constructively, etc. and stop demeaning and dissing people on this forum that has offered years of responding to the questions of concern by people who may or may not be stressed.  Personnaly, I see your behavior as disrupted and you should also read the rules against such behavior.  If you are against the culture of this forum, start your own forum and get a life!  
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328381_tn?1269367702
that 9 not seven also ive been on this forum as long as most not 1 month like you so mind your own business and quit being a moron that sifts thru posts to attack people like you did to me and ed34 . you must have been picked on when you were little and had your lunch money taken
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Avatar_m_tn
Why don't you answer my questions from the previous posts.  You revert to an ad homenin attack that has nothing to do with my questions.  I don't sift through posts but I believe you do but that is a meaningless aside, but that is an unnecessary aside.

You have a disdain for people who use knowledge in part acquired on this forum to help people who may have a similar problem.  That indicates a lack of respect for an education because the feeling for an education is a waste of time as an excuse and anyway one would say if info is needed ask a pro. Carry that thought as it appears done by the poster is consistent with the idea reading many posts, research, etc is a waste of time.  Not needed, ask the pro, and attack anyone's credibility if the source is not from a doctor!

You miss the point, if you have been with the forum for a longer time than I have been a member and you dismiss my years of reading.  The point is if you have been with the forum for as long as most people, then that begs the question why is there such a derth of medical knowledge?  The answer is quite obvious, you don't have the basic education to understand so progress is limited and usually one become's discouraged.  Your education is about at the 10 grade level, am I right?

Your ad homenin remarks says more about you than the target you may visit.  In psychology it is called "projection" which means one attributes to another based on their experience believing everyone thinks the same way as they do and have a similar experience.  It remains in the subconscious, and is very possible you have not progressed mentally passed 14 years old. Most mature people don't think in terms of school bullies and attribute something from that to ones demeanor.  Also, saying one has a Napolean complex is another indication of school time remarks.  Mature people judge other people in terms how wealthy, employment history, family, etc. Would I be correct to say you are from or still are in a troubled home environment and neighborhood?

Answer the questions I have asked for from the prior post. We can work it out trust me.  I didn't attack ed, I asked  an explanation from you regarding his prior posts because what you say out of one side of your mouth is not consisted with reality.  I'm beginning to believe you may have problem with expressing yourself, and you don't know what to believe and can't take a position!  
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367994_tn?1304957193
Now that my hand injury is at marginal ability for keyboarding, I will visit my comments on this thread as it appears I and others are put down or people such as I that have read and answered many posts does not qualify me or like people to any credibility when compared to gains in knowledge from doctors.

My EXPERIENCE does not favor relying totally on information from a doctor.  They do not always give the truth so it wise to get a second opinion and do your homework, ask yourself questions and research, dialogue with people on forums, etc...that is what I have done.  It is agreed some people do not have the time, basic ability to understand, etc., so the options are limited and almost requires one to depend on the doctor.  If you don't know anything about your medical condition, you are unable to ask the right questions!...that is my experience....don't mislead the readers and put matters in the correct perspective.  

Also, I have had a stent implant and during the procedure one is sedated to the extent they are able to follow instructions, but one shouldn't be asking questions during the procedure, and if the doctor answers (which is doubtfull) (s)he could break their concentration and penetrate the vessel so no one LEARNS BY HAVING A STENT IMPLANT  anything other than complication that could develop and furthermore one does not have a memory of the procedure (my experience).

******Now getting away from the trash talk that does not add anything to the specifics of the question:
_______________
QUOTE by Jon: "If you were sent for something as drastic as a cath it would have been because your doctor suspected something on the EKG  represented the possibility of some coronary artery disease or a previous MI with muscle damage, both of which would have shown up on a cath".

QUOTE by ed...."no, an angiogram cannot determine damaged tissue which was proved in my case where the LAD was so severely blocked".

>>>>You are both well informed, but Jon may be recognizing the versatility of a cath procedure.  There can be a coronary angiogram, and that evalutes the vessels, suspected atherosclerosis, congenital disease, valvular, etc.  That is the most common procedure.

But there can be pulmonary angiography, Aortic angiography.  

With the advancement of non-invasive imaging, less emphasis is placed on the cath ventriculogram.  It is part of the cardiac cath procedure, and it does hemodynamic measurement, and visualization of the left ventricle using contrast medium.  It remains an important aspect of a complete angiographic study.  It can show segmented dysfunction from ischemia or MI  that cause heart wall movement, can measure ventricular volumes, EF, mass, wall stress (hypokinesis, akenisis).  My cath procedure in ER determined I had had an MI and EF was 13%.  The common angiogram does not get into any measurements.

Right side cath can be useful to help diagnose cardiomyopathy, constrictive pericarditis, etc.

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159619_tn?1318997813
Thanks for putting things into perspective. There certainly has been a considerable amount of negative comments on the forum lately, it's getting to the point where I no longer get the feeling that we are a group of forum members working together to help others.

To cblm7, you wrote;

To; erijon

"i would have to agree with ed34 ive had 6 caths and lots of extensive tests we base our opinion on actual experiences not from reading tons of blogs"

What did I ever do to you? I have NEVER tried to play the role of doctor as others have. You do not know my history because I don't post it and I don't use it as a badge of honor on my posts. I have been on this forum longer than most everyone posting these days and I don't think you have a right to dismiss what I say publicly on some one's thread. I don't just "read blogs", I have had many issues to deal with and done many, many years of research. I try to stay conservative on my posts because I realize I am NOT a doctor, I state so in most posts. I have read your history and I am sorry you have experienced the issues you have, but don't think you have done more research than I have based on your experiences. If you want to act like a responsible member just send me a message when you disagree and we can discuss it but don't put me down on a thread.

I think most of us can take a lesson from Ken or Flycaster, when they post they simply interject facts to the discussion. Neither will play doctor just because they have had the experiences they have endured, they don't hide behind their experiences they just participate and isn't that what it's about?

Way too much doom and gloom responses lately. If I needed answers, I don't know that I would come to this forum after reading all the worse case scenarios thrown around out there now. A poster can't even celebrate a good test result without some members telling them they are still at risk, what point does that serve?

Disillusioned,

Jon
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